IDDF2021-ABS-0084 Tuberculosis as a common cause of post-liver transplant ascites

Abstract

<h3>Background</h3> Refractory ascites due to cirrhosis is one of the common indications for liver transplant (LT). Ascites are expected to resolve within 2-4 weeks following orthotopic liver transplant as the reversal of hemodynamic changes occurs by then. New-onset ascites after transplant has varied causes. The most common causes for the development of ascites after LT are hepatic inflow or outflow obstructions, hepatitis C, graft rejection, prolonged cold ischemia time. In addition, extrahepatic causes like infections, chronic kidney diseases, or heart failure can lead to ascites. <h3>Methods</h3> In this retrospective study, we aimed to assess the incidence and causes of ascites in post-transplant patients during the last year. <h3>Results</h3> A total of 95 patients underwent living donor liver transplantation (LDLT) in our institution. Seven out of 95 developed ascites post-liver transplant. The mean age of patients was 46± 18.98 years. 57% of patients were females. The indication of LDLT was decompensated cirrhosis in all patients. Three underwent LDLT for AUD-related liver disease, one each for NASH, chronic hepatitis B, Budd-Chiari syndrome, and Wilson disease. The mean time to ascites onset was 2.9 months. All the patients had ascites prior to liver transplant, out of which 5 (71%) had refractory ascites. 5 (71%) had HRS prior to transplant. Cold ischemia time was 98±19 min (IDDF2021-ABS-0084 Table 1). Five patients were diagnosed with tubercular ascites, one had tacrolimus-related proteinuria and ascites formation, and one more patient developed IgA nephropathy causing significant proteinuria and ascites. None of the patients had concomitant pulmonary tuberculosis. Rifampicin, levofloxacin, and ethambutol were initiated with a gradual introduction of isoniazid over the next 15 days. One of the patients developed ATT-induced liver injury and graft dysfunction after switching from rifampicin to rifabutin. He was treated with N-acetylcysteine and had delayed recovery with conservative management. <h3>Conclusions</h3> Tuberculosis is a common cause of post-transplant ascites. Although global data suggest vascular etiologies as a common cause of persistent ascites post-transplant, in the Indian scenario, tuberculosis should always be considered as a differential diagnosis while evaluating these patients. Being a potentially curable cause, it significantly improves graft survival after treatment.